Multiple management strategies work for UTIs

January 01, 0001

Multiple management strategies work for UTIs

This group of British researchers sought to assess the impact of different management strategies in urinary tract infections. They performed a randomised controlled trial done in a primary care setting involving 309 women aged 18-70 presenting with suspected urinary tract infection. Participants were randomized to five management approaches: empirical antibiotics, empirical delayed (by 48 hours) antibiotics, or targeted antibiotics based on a symptom score, a dipstick result (nitrite or both leukocytes and blood), or a positive result on midstream urine analysis. They measured symptoms severity and duration, as well as use of antibiotics.

The researchers report: "Patients had 3.5 days of moderately bad symptoms if they took antibiotics immediately. There were no significant differences in duration or severity of symptoms (mean frequency of symptoms on a 0 to 6 scale: immediate antibiotics 2.15, midstream urine 2.08, dipstick 1.74, symptom score 1.77, delayed antibiotics 2.11). There were differences in antibiotic use (immediate antibiotics 97%, midstream urine 81%, dipstick 80%, symptom score 90%, delayed antibiotics 77%) and in sending midstream urine samples (immediate antibiotics 23%, midstream urine 89%, dipstick 36%, symptom score 33%, delayed antibiotics 15%). Patients who waited at least 48 hours to start taking antibiotics reconsulted less (hazard ratio 0.57) but on average had symptoms for 37% longer than those taking immediate antibiotics (incident rate ratio 1.37), particularly the midstream urine group (73% longer, none of the other groups had more than 22% longer duration)."

The authors concluded: "All management strategies achieve similar symptom control. There is no advantage in routinely sending midstream urine samples for testing, and antibiotics targeted with dipstick tests with a delayed prescription as backup, or empirical delayed prescription, can help to reduce antibiotic use."

This study provides evidence supporting management strategies for UTIs that decrease cost and antibiotic use.

For the full abstract, click here.

BMJ 340:c199, 5 February 2010
© 2010 Little et al.
Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. P Little, M V Moore, S Turner, et al. Correspondence to P Little:

Category: U Urinary System Keywords: urinary tract infection, UTI, antibiotics, management, symptoms, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 9 March 2010

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